SynthesisJournal of general internal medicine2009
Genetic testing before anticoagulation? A systematic review of pharmacogenetic dosing of warfarin.
Synthesis in Journal of general internal medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 39 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature.Journal of racial and ethnic health disparities · 2015Pooled it
- Limited clinical utility of genotype-guided warfarin initiation dosing algorithms versus standard therapy: a meta-analysis and trial sequential analysis of 11 randomized controlled trials.The pharmacogenomics journal · 2015Pooled it
- Meta-analysis of Randomized Controlled Trials of Genotype-Guided vs Standard Dosing of Warfarin.Chest · 2015Pooled it
- Pharmacogenetics-Based versus Conventional Dosing of Warfarin: A Meta-Analysis of Randomized Controlled Trials.PloS one · 2015Pooled it
- Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews.The Cochrane database of systematic reviews · 2014Pooled it
- Optimal loading dose of warfarin for the initiation of oral anticoagulation.The Cochrane database of systematic reviews · 2012Pooled it
- Optimal loading dose for the initiation of warfarin: a systematic review.BMC cardiovascular disorders · 2010Pooled it
- Cost effectiveness of pharmacogenomics: a critical and systematic review.PharmacoEconomics · 2010Pooled it
- Prediction of phenprocoumon maintenance dose and phenprocoumon plasma concentration by genetic and non-genetic parameters.European journal of clinical pharmacology · 2011Trial
- A simple formula for predicting the warfarin dose in atrial fibrillation: development, external validation, and model comparison.Thrombosis journal · 2025Article
- Prediction of bleeding events using the VTE-BLEED risk score in patients with venous thromboembolism receiving anticoagulant therapy (Review).Experimental and therapeutic medicine · 2021Review
- The Ethics of Precision Rationing: Human Genetics and the Need for Debate on Stratifying Access to Medication.Public health genomics · 2020Article
- Design and evaluation of a pharmacogenomics information resource for pharmacists.Journal of the American Medical Informatics Association : JAMIA · 2017Article
- Bringing clinical pharmacogenomics information to pharmacists: A qualitative study of information needs and resource requirements.International journal of medical informatics · 2016Article
- Polymorphisms of CYP2C9, VKORC1, MDR1, APOE and UGT1A1 genes and the therapeutic warfarin dose in Brazilian patients with thrombosis: a prospective cohort study.Molecular diagnosis & therapy · 2014Article
- Pharmacogenetics in cardiovascular disease: the challenge of moving from promise to realization: concepts discussed at the Canadian Network and Centre for Trials Internationally Network Conference (CANNeCTIN), June 2009.Clinical cardiology · 2014Article
- Review
- Verification of pharmacogenetics-based warfarin dosing algorithms in Han-Chinese patients undertaking mechanic heart valve replacement.PloS one · 2014Article
- Genome-wide association studies in pharmacogenomics: successes and lessons.Pharmacogenetics and genomics · 2013Review
- Dabigatran for the prevention of stroke and systemic embolism in atrial fibrillation: A NICE single technology appraisal.PharmacoEconomics · 2013Review
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
5 authors.
Funding
Abstract
backgroundGenotype-guided initial warfarin dosing may reduce over-anticoagulation and serious bleeding compared to a one-dose-fits-all dosing method.
objectiveThe objective of this review was to investigate the safety and efficacy of genotype-guided dosing of warfarin in reducing the occurrence of serious bleeding events and over-anticoagulation. DATA SOURCES: The authors searched PubMed, EMBASE and International Pharmaceutical Abstracts through January 23, 2009, without language restrictions. Selected articles were randomized trials comparing pharmacogenetic dosing of warfarin versus a "standard" dose control algorithm in adult patients taking warfarin for the first time. REVIEW
methodsTwo reviewers independently extracted data and assessed study quality using a validated instrument. The primary outcomes were major bleeding and time spent within the therapeutic range International Normalized Ratio (INR). Secondary outcomes included minor bleeding, thrombotic events and other measures of anticoagulation quality.
resultsThree of 2,014 studies (423 patients) met the inclusion and exclusion criteria. Differences in study quality, dosing algorithms, length of follow-up and outcome measures limited meta-analysis. Summary estimates revealed no statistically significant difference in bleeding rates or time within the therapeutic range INR. The highest quality study found no significant difference in primary or secondary outcomes, although there was a trend towards more rapid achievement of a stable dose (14.1 vs. 19.6 days, p = 0.07) in the pharmocogenetic arm.
conclusionsWe did not find sufficient evidence to support the use of pharmacogenetics to guide warfarin therapy. Additional clinical trials are needed to define the optimal approach to use warfarin pharmacogenetics in clinical practice.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.